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Massachusetts Small Business Health Insurance Alternatives

Due to state insurance regulations and higher than average group health insurance costs resulting, it is in the Massachusetts small business owner's best interest to personally explore all their health insurance options through an independent broker that specializes in the health insurance area. This way the business owner has a better chance of finding out about all their options and those that are the most cost effective for his business.

The plans with the least bells and whistles and the least restrictions and best access to providers at a fair price will always provide the best coverage for your money. 

For small groups of generally between 2 and 50 employees, here's an example of what to look for in a quality group health plan typically found only in PPO plans in Massachusetts...

  • Low co-pays for office visits, Prescriptions, Emergency Room, Urgent Care co-pays (or even better -- 100% coverage after your out of pocket maximum is reached)
  • NO Blacklisted Prescriptions Drugs
  • Nationwide access to nearly 4000 hospitals and almost 400,000  doctors -all considered "in-network" allowing you to "keep your doctors"
  • Coverage outside the network for an additional out-of-pocket cost
  • $5 million lifetime maximum both inside and outside the network

The "bottom line" is it is possible to get a lot more important benefits for a lot less cost with a PPO plan with a quality national network of providers, such as Private Healthcare Systems www.phcs.com,  if you know how to shop. The trick is knowing where to look for carriers with sensible plan designs and reasonable premiums. Second only to pure indemnity plans, PPO plans however, typically are the MOST EXPENSIVE types of health insurance due to the fact that the insured person has the MOST CONTROL  over his care and the MOST FREEDOM to go anywhere he chooses for care.

Too many groups rule out PPO plans too soon because they think they'll be too expensive. In some cases with some carriers, they may be right BUT IMPLEMENTING AN HRA (Health Reimbursement Arrangement) along with a PPO makes obtaining one a lot more feasible as you'll see in the example below. 

We found the following PPO options with  Blue Cross Blue Shield of Massachusetts; Aetna, Guardian and John Alden for a company in Boston with 6 employees (4 families and 2 individuals) . The average employee age was 40.

Carrier  A B C D  D w/ HRA
Office Visit Co-pay $15 $15 $10 $20 $20
E.R. Co-pay $50 $125 $50 $50 $50
Rx Deductible $250(Ind.)/
  None None None
Rx Co-pays $10/$20/$35   $15/$25/$40 $15/$25/$50 $15/$25/$50
Deductible $1000/$2500 $3000/$6000 $500/$1500 $500/$1500 $500/$1500
Hospital Admission Co-pays None $500 None None None
Coinsurance % In-network 100% 80% 100% 50% 50%
Out of Pocket Max. In-network  N/A $5000/
N/A $2500/$5000 $2500/$5000-
0  N/A after HRA reimbursement
Total In-network Deductibles&
$500/$1500 $3000/$6500 $500/$1500 after HRA reimbursement
Group Monthly Premiums $4152.33   $5027.75  $3400.00 $3400.00

Since the carrier that offered plan "A" had a requirement that
51% of a groups employees work in Massachusetts, we had to rule that one out as half of the employees of this company worked out of state.  The carrier offering Plan "B" obviously wasn't even in the ball park as far as protection was concerned. We didn't even 
bother to check the rates. We thought the price would have had to have been practically FREE to even consider that plan.

Carriers offering plans outlined in columns "C" and "D" were left.
Which one seems to provide the best value for the money?

With nearly $20,000 savings provided in plan "D", we suggested that implementing a custom Health Reimbursement Arrangement (HRA) to reimburse employees for the extra $2500 out of pocket maximum using the premium savings that Plan "D" provided would give the employees the same 100% benefit after the $500 deductible as in plan "C" without having to pay the higher premium for the benefit made the most sense since the the company's total risk was only $25,000, and that was ONLY if 100% of all of their employees and their dependents all were hospitalized with a major illness or injury the same year, (which would likely put the company out of business and would likely never happen). 80% of the company's employees and their dependents would need to be hospitalized and require full reimbursements just to equal the cost of plan "C" which would also, it is safe to say, probably never happen.

What was more likely to happen in a BAD year was that perhaps 30% of them  might need their full reimbursement. So we figured 30% of the entire risk was only $7500 which would leave the company with over $12,000 cash savings - In a BAD YEAR, no less!

Wondering which carrier offered which plan? Call us to find out.

"How much can you save?" This depends on a number of factors but our average  prospective client  currently insured with a popular HMO or POS plan saves between $1000 to $3000 per covered employee per year! 

"Why hasn't my broker shown me this before?" you may be wondering. There are a few reasons but the primary answer is. simply due to the fact that not every independent broker is authorized to offer it .

By using a broker who only offers the advertised plans you've been missing out on big opportunities to save on group health insurance premiums. You've also been settling for plans with more restrictions  and smaller networks. Isn't it time you got a better health insurance value through Health Plan Specialists? See if your company qualifies.  All it takes is 6 simple steps....